Identification of abnormal patterns of evolution of neurocysticercosis cysts and what they might indicate

Few studies have described unexpected patterns of cyst evolution for neurocysticercosis (NCC), an infection of the central nervous system with the larval stage of the pork tapeworm, Taenia solium. We used data from a randomized controlled trial on albendazole treatment, conducted in Ecuador and including 178 NCC patients who had imaging at months one, six, 12, and 24 to examine unexpected patterns of NCC cyst evolution by potential explanation. Over half (57.2%) of patients exhibited an unusual pattern of cyst evolution. The most common pattern was consistent with possible cyst migration (44.8%), followed by reverse transitioning of NCC cysts to earlier phases (16.6%). Only 1.4% had evidence suggesting a new infection. Documenting unexpected patterns of NCC cyst evolution and exploring potential explanations for these patterns may inform radiologists' reading of NCC patient scans to improve care and generate future research ideas to help us better understand this parasite and disease.